Cypress Creek, Cy-Fair VFD, Northwest EMS (Tomball), Harris County ESD-48 and HCEC are cut from the same cloth- both are fairly high-functioning, 911-only organizations. They are operated as 501c(3) nonprofit corporations, so there's not the overarching drive to profit; although both operations are cost-conscious. Structurally, this means that the organization 'exists' in essentially the same market space as any other non-municipal service provider, but Texas has what it calls Emergency Services Districts, which are special taxing entities that levy sales and/or property taxes to support emergency services within specific areas. Cypress Creek serves "ESD-11", the area defined on our website; Tomball is ESD-8, Cy-Fair is ESD-9, HCEC is ESD-1, etc. Basically, instead of supporting the money-losing business of 911 with transfers, we're supported by tax dollars from the ESD that contracts us
and what we recover in billing. The ESD effectively replicates a city government, or augments it (in the case of Tomball).
This means that we get treated a
lot better than private ambulance workers, and are generally roughly equivalent to county and Fire in terms of pay and benefits. A common thread between most of the Houston area's 911 EMS is that we're making better money than most of the nation for about the same work, and with some exceptions,
all we do is 911. For example, I'll make around $58k gross this year with minimal overtime (even counting Harvey), which is low-average for area medics. Pay in this area tends to run in the very high teens to low twenties per hour, with generous benefits packages. Creek pays 100% of our health insurance premium and 90% of our entire family, Cy-Fair and HCEC are similar with high-but-not-as-high percentages for family but more bonus opportunities and Kelly schedules as opposed to Creek's 24/72. For Creek, I think we start our brand-new "P-1" new medics at like $17.85, but I hired on at a P2 rate and rocketed through the orientation and credentialing process. Currently, I'm at $22.15 an hour, which isn't terrible at all (one year as a P2). It makes it
really hard to move anywhere else. Part of that is regional cost of living, part of it is being a non-profit, and part of it is because our admin really does try and do the right thing by us all. It's not the kind of place you see management rolling around in Maseratis off of the fruits of your labor.
Operationally, since all we do is 911, you'll have to get that mindset (no call is BS, everything is someone's emergency, etc). All of the agencies in this area are pretty progressive and focused on patient experience and outcome. Everyone has a slightly different approach. Creek runs P2/B, P2/P1 or P2/AEMT on trucks; P1s can run ALS calls but all trucks have a P2 aboard who is trusted to 'run' the truck. However, we can triage calls to our partner (B, AEMT or P1) based on the specific call and complaint, and this allows everyone to get good experience. P1s
are fully credentialed paramedics and are able to do everything in our scope of practice as allowed by protocol, but they're
also developmental levels so it is the discretion of the P2 as to what they should or shouldn't take. The P1 is intended for new medics to gain familiarity with the role and isn't a punishment- I rather like the way it's implemented here and plan on replicating it when I eventually run somewhere. HCEC is mostly P/P, as is MCHD and Cy-Fair (although Cy-fair does have a considerable number of EMTs as well). The credentialing process at Creek is as follows: NEOP + driver's training (concurrent), then "Basic-in-charge" for everyone, and ALS academy (2 weeks of really, really good training on the Creek Way, totally worth it), then you test for P1. Depending on management's opinion of your abilities, you might find yourself at P1 for a while to develop or be ushered straight through to P2. I think that's totally fair, because P1 isn't treated as a penalty, it's a developmental post. I was a BIC for like a day and a P1 for a few days I think? The levels aren't as stratified as some other organizations and the timelines at Creek are flexible. Clearance is a test, scenario/talk with the medical director, and a review of your perceived abilities. To their credit, Education also proactively works to develop you, and there's a lot of opportunities to do that (EMT/Paramedic classes, classes in general, community relations, etc). We're also starting a community medic program and have the tactical medics, so those departments exist too. Communications is its own separate world where medical training isn't strictly necessary, of that I know little. Cy-fair has a similarly flexible NEOP and clearing process. HCEC and MCHD are lengthier, drawn-out, with more testing, scenarios, more reviews, etc. I've heard the minimum is six months at either to fully clear as an attendant, and for most new medics, you're probably at least a year in training to in-charge status. All three agencies have a 'tiered' medic system with what we call "P3" or critical-care or supervisor or whatnot as well. At Creek, supervisors carry blood products, vents and some really rarely-used items on their trucks and they (or a P3) has to be physically present for RSI to be attempted, although who does what is up to the P3 and the crew. Other places have slightly different takes on it, but I think it's the same at HCEC (I know they have to ask for ketamine, we can give it autonomously). I initially chafed at this, but it's nowhere near as obtrusive or irritating as I thought it would be, and I think it does improve patient safety and workflow to have an extra highly-trained medic on-scene on something complex.
MCHD and HCEC both have pumps and vents on every truck, and they're actively fielding Powerloads. We'll start eventually. Our vents come with supervisors, so it's not like we don't have them- we just don't use them enough to justify buying one for everyone. We use X-series Zolls, LUCAS, etc. That's pretty common across the fleets, although HCEC uses mRX and Cy-Fair uses LP-15. Everyone up here has video laryngyscopes, EZ-IO, RSI, etc. It's probably the best-equipped EMS region in the nation.
Schedule-wise, we run a core 24/72 (oxxxoxxxoxxx) out of thirteen stations, and we're very busy. Stand-up 24s or nearly-sleepless nights are common and we do pull trucks from slower stations to post in the Vortex frequently. Honestly, I'm not a fan of the 24-hour schedule, but that's a different argument, so I work the "peak truck", which is exactly what it sounds like- we cover peak hours and try to intercept calls for the 24-hour trucks. We work a 12-hour shift, and they're trying to add more peak trucks to the schedule- currently, we've got one near-permanent (mine) and one staffed on weekends (sometimes). Peak trucks don't have a station, we post at hotspots and run calls all day. There is flexibility within the schedule and our scheduler is awesome- for example, I am pursuing a Master's degree and it is far easier with her help and my opposite's cooperation. The peak truck's base schedule is a 42-hour workweek, which really means a 4/3 3/4 or a 2/2/3 schedule (2 48-hour weeks and 2 36-hour weeks). ESD-48 also runs 24/72. HCEC and Cy-Fair run a Kelly schedule mimicking HFD with debit days, and MCHD is on a nine-day rotation of some sort. Functionally though, it's all the same- generally 24-hour station-based shifts in busy urban/suburban EMS.
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